Technical aspects of cytoreductive surgery.

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Peritoneal surface malignancy presents complex treatment challenges.
• Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a standard treatment.
• Technical aspects of CRS require consensus for optimal patient outcomes.

Purpose of the Study:

• To establish consensus on key technical aspects of cytoreductive surgery (CRS) for peritoneal surface malignancy.
• To address conflicting viewpoints on peritonectomy, nodule management, and ostomy indications.
• To refine best practices for CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) procedures.

Main Methods:

• Consensus was achieved using the Delphi process at the Fifth International Workshop on Peritoneal Surface Malignancy.
• Five contentious technical points were discussed by a panel of experts.
• Expert opinions were gathered and synthesized to reach agreements on surgical techniques.

Main Results:

• Partial parietal peritonectomy is recommended for most conditions, excluding mesothelioma.
• Radical parietal peritonectomy was not favored by any expert.
• Electrovaporization of small (<2.5 mm) non-infiltrating mesenteric nodules is considered appropriate.
• Intestinal anastomoses should be performed after HIPEC in the closed technique.
• A flexible approach to protective ostomies, based on individual patient needs, was agreed upon.

Conclusions:

• Consensus was reached on critical technical elements of CRS for peritoneal surface malignancy.
• The findings provide guidance for optimizing CRS and HIPEC procedures.
• Expert agreement supports a tailored approach to surgical management and ostomy use.